Quality Improvement

On Friday, Jan. 30, at 9:30 a.m., Stephanie Worrell, MD, of the University of Arizona, presented STS Perforation Guidelines during the "Esophageal Perforation Management" session. Her talk introduced a new Society of Thoracic Surgeons (STS) Expert Consensus Document designed to improve the diagnosis and management of esophageal perforation, a rare but potentially fatal condition.

Image

Esophageal perforation, often a complication of endoscopic procedures, requires early diagnosis, as mortality and morbidity increase if treatment is delayed beyond 24 hours. Despite advances in treatment, management remains inconsistent due to the condition’s rarity and limited clinical data.

To address this gap, the STS convened a multidisciplinary panel of thoracic surgeons and gastroenterologists, who reviewed studies from the past 14 years to develop consensus statements on diagnosis, treatment, and long-term care. For stable patients with confirmed perforation, the consensus supports endoscopic therapies when matched appropriately to anatomy and operator expertise. Surgical intervention remains essential for unstable patients or complex cases.

In her talk, Dr. Worrell discussed how the guidelines provide clarity in clinical scenarios that often prompt uncertainty. “These recommendations clarify when further investigation is appropriate and when it’s safe to observe or discharge,” she said. She notes that the guidelines are particularly valuable for conditions like spontaneous pneumomediastinum where further workup may be unnecessary. Additionally, there is now strong data for CT esophagrams and growing evidence for endoscopic approaches that are not yet used consistently.

During the Airway Issues session on Friday, Jan. 30 at 1:30 p.m., Joseph Nellis, MD, of Duke University Medical Center, will present the Richard E. Clark Memorial Paper, Impact of Preoperative Tracheostomy on Outcomes Following Congenital Cardiac Surgery: A Study of the STS Congenital Heart Surgery Database, at STS 2026. In this presentation, Dr. Nellis will examine how preoperative tracheostomy affects outcomes following congenital cardiac surgery, an area with limited prior data despite longstanding concerns about risk in this population.

Image

Congenital cardiac surgery patients with preoperative tracheostomy represent a small but increasingly recognized group with complex medical needs. To better understand how tracheostomy status influences surgical outcomes, Dr. Nellis and colleagues analyzed national registry data spanning a decade of congenital cardiac operations, comparing patients with preoperative tracheostomy to those without this airway history.

Overall, patients with preoperative tracheostomy experienced higher rates of postoperative complications, readmissions, and mortality compared with those without tracheostomy. Even after accounting for differences in baseline risk, preoperative tracheostomy remained associated with an increased likelihood of infection-related complications and early mortality, though it was not linked to longer hospital stays or higher overall morbidity.

In his presentation, Dr. Nellis will outline the implications these findings inform risk stratification and surgical planning for children with complex airway and cardiac disease. He emphasizes that while preoperative tracheostomy identifies a higher-risk patient population, it should not, by itself, exclude patients from consideration for definitive congenital cardiac surgery.
 

On Thursday, January 29, the Society of Thoracic Surgeons (STS), in collaboration with the International Society for Heart and Lung Transplantation (ISHLT), hosted the inaugural STS/ISHLT Lung Transplantation Symposium as part of the STS 62nd Annual Meeting. This full-day specialty session provided a practical, multidisciplinary review of contemporary lung transplantation, covering donor selection through long-term management with an emphasis on intraoperative decision-making and complex clinical scenarios.

“Through its practical, comprehensive approach, the symposium offered attendees an in-depth perspective on modern lung transplantation,” said organizing chair Kewal Krishan, MD. “The program equipped surgeons and care teams with strategies for both routine and highly complex cases.”

The program combined didactic lectures, live debates, and case-based panels to highlight advances in donor management, organ preservation, surgical techniques, and perioperative care. Attendees earned CME credits while engaging in detailed discussions of common challenges in lung transplantation surgery.

Sessions delivered a case-based overview across the operative spectrum—from donor management and organ preservation to complex intraoperative rescue. Faculty reviewed retrieval strategies in donation after brain death and circulatory death, surgical implantation techniques, perioperative anesthesia and hemodynamic management, and the use of ECMO or cardiopulmonary bypass. Advanced scenarios, including robotic, redo, and heart–lung transplantation, concluded with interactive discussions focused on real-world, high-risk cases.

As the population undergoing mitral valve surgery continues to age, the choice between repair and replacement has taken on new urgency. At the "Masters of the Mitral Valve" session on Thursday, Jan. 29 at 10:10 a.m., Dr. Allen Razavi of Cedars-Sinai Medical Center will address this issue in the Is Degenerative Mitral Valve Repair Superior to Replacement in Patients Aged >65 Years? presentation.

Image

Drawing from a large national cohort within the Society of Thoracic Surgeons Adult Cardiac Surgery Database linked with Medicare data, Dr. Razavi and his team compared long-term outcomes for patients aged 65 and older who underwent mitral valve repair with those who received mitral valve replacement. Their objective was to evaluate differences in survival, major complications, and the need for future mitral valve interventions across treatment strategies.

The study found that mitral repair was associated with significantly improved long-term survival compared with replacement, with benefits persisting across much of the older age spectrum. Patients who underwent repair also experienced lower rates of heart failure readmission, stroke, and major bleeding. While overall reintervention rates were similar between groups, repair patients tended to require earlier surgical reintervention, whereas replacement patients were more likely to undergo late transcatheter procedures.

Dr. Razavi will present findings showing how evolving treatment options and advances in repair techniques prompted the team to reassess outcomes in this population. The growth of transcatheter mitral therapies and improvements in surgical durability have heightened the need to revisit traditional assumptions about when repair should be favored over replacement.

The Richard E. Clark Memorial Paper on day one of STS 2026, Optimal Management for Moderate Aortic Stenosis at the Time of Coronary Artery Bypass Grafting, will be featured during the “Optimizing AVR: Aiming for Perfection” session on Thursday, Jan. 29, at 11:00 a.m. In this presentation, Pey-Jen Yu, MD, of Northwell Health, will explore how best to manage moderate aortic stenosis (AS) in patients undergoing coronary artery bypass grafting (CABG), a question that has grown increasingly important as transcatheter approaches continue to reshape treatment pathways.

Image

Drawing from a large cohort in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (ACSD), linked with national inpatient records, Dr. Yu and colleagues compared outcomes for patients who had isolated CABG versus those who received CABG combined with aortic valve replacement (AVR). The goal was to understand both the immediate risks and the longer-term implications of addressing—or deferring—valve intervention in patients with moderate AS.

The study found that patients undergoing CABG alone experienced slightly lower operative risk, but they were more likely to require later aortic valve intervention and were at increased risk for readmission related to heart failure. Meanwhile, those who underwent concomitant AVR faced a higher initial risk but significantly lower likelihood of needing future valve procedures. Importantly, mid-term survival was similar between the two groups.

In her presentation, Dr. Yu will highlight how the rapid expansion of transcatheter valve therapies served as a key motivation for this work, prompting the team to revisit longstanding assumptions about when to intervene on a moderately stenotic valve during open-heart surgery.
 

During the Saturday, Jan. 31, 7:50 a.m. presentation of the James S. Tweddell Memorial Paper for Congenital Heart Surgery, Elaine Griffeth, MD, of Mayo Clinic, will present new research as part of the “Research in Focus: Distinguished Abstracts” session at the 2026 Society of Thoracic Surgeons (STS) Annual Meeting. Her talk, Extended Validation of an Institutional Machine Learning Model for Postoperative Morbidity and Mortality Risk in Adult Congenital Heart Disease Patients Undergoing Cardiac Reoperation, will explore how advanced risk modeling can better inform surgical decision-making for adults with congenital heart disease (CHD).

Image

Adults with CHD represent a growing and medically complex population. Most were born with structural heart defects and underwent surgery early in life, yet many require additional cardiac operations as adults. Prior surgeries, evolving anatomy, and long-term health challenges make it difficult to accurately estimate operative risk using existing tools designed for the broader adult cardiac surgery population, highlighting the need for a CHD-specific national risk assessment model.

The study analyzed cases from the STS Adult Cardiac Surgery Database spanning several years, building on prior Mayo Clinic work using machine learning and logistic regression. Seven factors were strongly associated with postoperative morbidity and mortality: sex, age, single-ventricle physiology, surgical urgency, kidney function, ejection fraction, and prior heart operations.  

“This is a work in progress,” says Dr. Griffeth. “We want to have high reliability in the surgeries we are offering, and we are trying to tailor this model with data from past patients. The more informed patients are about their risks for surgery, the better.”
 

Lung cancer causes more deaths in the United States each year than breast, colon, and prostate cancers combined. Yet, despite strong evidence showing that annual screening with low-dose CT (LDCT) scans significantly reduces lung cancer mortality among high-risk individuals^[1],^[2], fewer than 18.2% of eligible patients currently undergo screening.

Simultaneously published in The Annals of Thoracic Surgery, The Journal of the American College of Radiology, and The International Journal of Radiation Oncology, Biology, Physics and jointly issued by The Society of Thoracic Surgeons (STS), The American College of Radiology (ACR), and The American Society for Radiation Oncology (ASTRO), the article examines recurring methodological flaws in the literature that may limit knowledge of, and access to, lung cancer screening (LCS).

The editorial originated from the STS Lung Cancer Screening Task Force and was led by its chair, Elliot Servais, MD, Department of Surgery at Lahey Hospital & Medical Center.

“In this paper, we address these misconceptions head-on with the goal of expanding access to screening and saving more lives from lung cancer,” said Dr. Servais. “Lung cancer screening saves lives. Multiple high-quality studies have clearly demonstrated its benefit. Despite this strong evidence, persistent misinformation about perceived harms continues to limit the uptake of this life-saving test.”

The authors note that methodological shortcomings in published research—including overestimation of downstream complications, misrepresentation of false-positive rates, and flawed analyses of CT-related radiation risk—may deter patients and clinicians from lung cancer screening, highlighting the need for accurate, evidence-based communication of its benefits and risks.

The full joint editorial is now available online:

[1] DOI: 10.1056/NEJMoa1911793 
[2] DOI: 10.1056/NEJMoa1102873